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Optimal timing of invasive intervention for high-risk non-ST-segment-elevation myocardial infarction patients
Juan-Juan Zheng1,2, Yue-Qiao Si1,2, Tian-Yang Xia2
1Department of Geriatrics, Southwest Hospital, Third Military Medical University, Chongqing, China.
Insights
For high-risk non-ST-segment-elevation myocardial infarction (NSTEMI) patients, early percutaneous coronary intervention (PCI) within 3-14 hours is optimal. Delayed PCI benefits those with chronic kidney injury, while immediate PCI may increase adverse events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Non-ST-segment-elevation myocardial infarction (NSTEMI) requires timely intervention.
- Percutaneous coronary intervention (PCI) timing is crucial for managing high-risk NSTEMI patients.
- Optimal timing strategies for PCI in NSTEMI remain under investigation.
Purpose of the Study:
- To compare the effectiveness of immediate, early, and delayed PCI strategies in high-risk NSTEMI patients.
- To identify predictors of major adverse cardiac events (MACE) in NSTEMI patients undergoing PCI.
- To determine the optimal timing window for PCI to minimize MACE.
Main Methods:
- Retrospective review of 657 NSTEMI patients treated between 2011-2021.
- Patients were categorized into immediate (<2h), early (2-24h), and delayed (≥24h) PCI groups.
- Multivariable Cox regression and nonlinear models were used to analyze outcomes.
Main Results:
- Early PCI (3-14h) significantly reduced MACE compared to immediate or delayed PCI.
- Predictors for MACE included early PCI, diabetes, and severe coronary stenosis.
- Delayed PCI showed superiority in NSTEMI patients with chronic kidney injury.
Conclusions:
- An early PCI strategy (3-14h) is recommended for high-risk NSTEMI patients to reduce MACE.
- Immediate PCI may increase MACE rates.
- Delayed PCI is beneficial for NSTEMI patients with chronic kidney injury.
Objective:
To compare the immediate, early, and delayed percutaneous coronary intervention (PCI) strategies in non-ST-segment-elevation myocardial infarction (NSTEMI) patients with high-risk.
Methods:
Medical records of patients treated at the Daping Hospital, Third Military Medical University, Chongqing, China between 2011 and 2021 were retrospectively reviewed. Only patients with complete available information were included. All patients assigned into three groups based on the timing of PCI including immediate (< 2 h), early (2-24 h) and delayed (≥ 24 h) intervention. Multivariable Cox hazards regression and simpler nonlinear models were performed.
Results:
A total of 657 patients were included in the study. The median follow-up length was 3.29 (interquartile range: 1.45-4.85) years. Early PCI strategy improved the major adverse cardiac event (MACE) outcome compared to the immediate or delayed PCI strategy. Early PCI, diabetes mellitus, and left main or/and left anterior descending or/and left circumflex stenosis or/and right coronary artery ≥ 99% were predictors for MACE outcome. The optimal timing range for PCI to reduce MACE risk is 3-14 h post-admission. For high-risk NSTEMI patients, early PCI reduced primary clinical outcomes compared to immediate or delayed PCI, and the optimal timing range was 3-14 h post-admission. Delayed PCI was superior for NSTEMI with chronic kidney injury.
Conclusions:
Delayed invasive strategy was helpful to reduce the incidence of MACE for high-risk NSTEMI with chronic kidney injury. An immediate PCI strategy might increase the rate of MACE.
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